Çocuk Yoğun Bakım Ünitesi'nde Kandida Sepsisi ve Risk Faktörleri

Yıl 2020, , 264 - 268, 27.05.2020

Mutlu Uysal Yazıcı , Ebru Azapağası , Erhan Özel Furkan Donbaloğlu Selman Kesici Fatma Nur Öz

https://doi.org/10.20515/otd.535313

Öz

Fungal infeksiyon sıklığı son
yıllarda artış göstermektedir. Hastane kaynaklı fungal infeksiyonların büyük
bir kısmı Candida türleri ile
oluşmaktadır. Günümüzde; kronik hastalık, invaziv işlem sıklığındaki artış ve geniş
spektrumlu antibiyotik tedavi uygulamaları sonucunda kandidemi görülme sıklığı artmaktadır.
Çocuk yoğun bakım ünitelerinde en sık görülen invaziv fungal infeksiyon
etkenleri Candida ve Aspergillus türleridir. İnvaziv fungal enfeksiyonlar
morbidite ve mortaliteyi artırmaktadır. Bu çalışmada çocuk yoğun bakım
ünitesinde izlenen Candida albicans
ve non-albicans Candida türlerine
bağlı kandidemi gelişen olguların demografik ve laboratuvar özellikleri ile
risk faktörleri açısından değerlendirilmesi amaçlanmıştır. Çalışmaya Ocak 2014-
Şubat 2018 tarihleri arasında çocuk yoğun bakım ünitesinde takip edilen, 1
ay-18 yaş arası kandidemi gelişen 20 hasta dahil edildi. Kandidemi tanısı
Hastalık Kontrol ve Önleme Merkezi tarafından belirlenen sürveyans tanı
kriterlerine göre konuldu. Her hasta için demografik veriler, klinik ve
laboratuvar bulguları ve uygulanan girişimler kaydedildi. Hastaların ortanca
yaşı 12.5 aydı ve %50 'si (n=10) kız, %50'si (n=10) erkekti. Kandidemi risk
faktörlerinden santral venöz 17 hastada (%85), nötropeni iki hastada,
intraabdominal cerrahi öyküsü bir hastada mevcutken, immünsüpresif tedavi alan
hasta yoktu. Kandidemi tanısı aldığında hastaların hepsi invaziv mekanik
ventilasyonda izlenirken, mekanik ventilatörde medyan kalış süresi 33 gün
olarak bulundu. En sık üreyen kandida türü C.
albicans 9 (%45)  idi.  Non-albicans kandida 11 (%55) hastada
saptandı ve en sık görülen(%40; n=8)  C. parapsilosis idi. Tüm tedavi
yaklaşımlarına rağmen yedi (%35) hasta kaybedildi. C. albicans üreyen hastaların %44.4 'ü, non-albicans kandidemisi
olanların %36.4'ü kaybedildi. Candida türü ile mortalite oranları arasında
istatiksel olarak anlamlı fark bulunmadı ( p>0.05). Kandidemiye yol açan
risk faktörlerinin ortadan kaldırılması, üreme olduktan sonra kateterin hızlıca
çekilmesi kandidemi mortalitesini azaltabilir.

Anahtar Kelimeler

Kandida sepsisi, çocuk yoğun bakım, mortalite

Candidemia and Risk Factors in Pediatric Intensive Care Unit

Öz

In recent years, the incidence
of fungal infections has increased. The majority of hospital-acquired fungal
infections are caused by Candida species.
Recently, with an increase of chronic diseases frequency and invasive
procedures, the incidence of candidemia increases as a result of administration
of broad-spectrum antibiotic. The most common invasive fungal infections in the
pediatric intensive care unit are Candida
and Aspergillus species. Invasive
fungal infections increase morbidity and mortality. The aim of this study was
to evaluate the demographic, laboratory and risk factors of pediatric patients
who developed candidemia due to C. albicans
and non-albicans Candida species in
pediatric intensive care unit. In this study, 20 patients aged between  1 months and  18 years old and who developed candidemia in
between January 2014 and February 2018 were included. The diagnosis of
candidemia was done according to the diagnostic criteria of surveillance which
defined by the Center for Disease Control and Prevention. Demographic data,
clinica/laboratory findings, and interventions have been recorded. The median
age of  the patients was 12.5 months and
50% (n=10) were girls and 50% (n=10) were boys. There were 17 patients with
catheters (85%), two patients with neutropenia and one patient with
intraabdominal surger;  none of the
patients had history of immunosupression. All patients have invasive mechanical
ventilation when they were diagnosed with candidemia. The median duration of
mechanical ventilation was 33 days. The most common isolated candida specie was
C. albicans (n=9; 45%).  Non-albicans
Candida species were detected in 11 (55%) patients and most common type was
C. parapisilosis (n=8;40%). Despite
appropriate treatment, 7 (%35) patients were died. In whole study group, 44% patients
with C. albicans and 36.4% of
patients with non-albicans Candida was
died. No  statistically significant
difference was found between the mortality rates and the type of  isolated candida species (p>0.05). Elimination
of risk factors leading to candidemia sepsis, rapid removal of the catheter
after candida reproduction may reduce the mortality associated with candidemia. 

Anahtar Kelimeler

candidemia, pediatric intensive care unit

Kaynakça

• 1. Brissaud O, Guichoux J, Harambat J, Tandonnet O, Zaoutis T. Invasive fungal disease in PICU: epidemiology and risk factors. Annals of intensive care. 2012 Feb 22;2(1):6. PubMed PMID: 22356683. Pubmed Central PMCID: 3306204.
• 2. Filioti J, Spiroglou K, Roilides E. Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome. Intensive care medicine. 2007 Jul;33(7):1272-83. PubMed PMID: 17503015.
• 3. Zaoutis T. Candidemia in children. Current medical research and opinion. 2010 Jul;26(7):1761-8. PubMed PMID: 20513207.
• 4. Zaoutis TE, Argon J, Chu J, Berlin JA, Walsh TJ, Feudtner C. The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2005 Nov 1;41(9):1232-9. PubMed PMID: 16206095.
• 5. Blyth CC, Palasanthiran P, O'Brien TA. Antifungal therapy in children with invasive fungal infections: a systematic review. Pediatrics. 2007 Apr;119(4):772-84. PubMed PMID: 17403849.
• 6. Lausch KR, Dungu KHS, Callesen MT, Schroder H, Rosthoj S, Poulsen A, et al. Pediatric Candidemia Epidemiology and Morbidities: A Nationwide Cohort. The Pediatric infectious disease journal. 2018 Sep 29. PubMed PMID: 30281546.
• 7. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control. 2008 Jun;36(5):309-32. PubMed PMID: 18538699.
• 8. Urrea M, Pons M, Serra M, Latorre C, Palomeque A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. The Pediatric infectious disease journal. 2003 Jun;22(6):490-4. PubMed PMID: 12799503.
• 9. Richards MJ EJ, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1999;103(4):e34.
• 10. Hegazi M, Abdelkader A, Zaki M, El-Deek B. Characteristics and risk factors of candidemia in pediatric intensive care unit of a tertiary care children's hospital in Egypt. Journal of infection in developing countries. 2014 May 14;8(5):624-34. PubMed PMID: 24820467.
• 11. Vogiatzi L, Ilia S, Sideri G, Vagelakoudi E, Vassilopoulou M, Sdougka M, et al. Invasive candidiasis in pediatric intensive care in Greece: a nationwide study. Intensive care medicine. 2013 Dec;39(12):2188-95. PubMed PMID: 23942859.
• 12. Agin H, Devrim I, Isguder R, Karaarslan U, Kanik E, Gunay I, et al. Risk factors for candidemia in pediatric intensive care unit patients. Indian journal of pediatrics. 2014 Nov;81(11):1158-62. PubMed PMID: 24623095.
• 13. Celebi S, Hacimustafaoglu M, Ozdemir O, Ozkaya G. Nosocomial candidaemia in children: results of a 9-year study. Mycoses. 2008 May;51(3):248-57. PubMed PMID: 18399906.
• 14. Gonzalez GM, Trevino-Rangel Rde J, Palma-Nicolas JP, Martinez C, Gonzalez JG, Ayala J, et al. Species distribution and antifungal susceptibility of bloodstream fungal isolates in paediatric patients in Mexico: a nationwide surveillance study. The Journal of antimicrobial chemotherapy. 2013 Dec;68(12):2847-51. PubMed PMID: 23869052.
• 15. Ergul AB, Isik H, Altintop YA, Torun YA. A retrospective evaluation of blood cultures in a pediatric intensive care unit: a three year evaluation. Turk pediatri arsivi. 2017 Sep;52(3):154-61. PubMed PMID: 29062249. Pubmed Central PMCID: 5644582.
• 16. Dutta A, Palazzi DL. Candida non-albicans versus Candida albicans fungemia in the non-neonatal pediatric population. The Pediatric infectious disease journal. 2011 Aug;30(8):664-8. PubMed PMID: 21372750.
• 17. Singhi SC, Reddy TC, Chakrabarti A. Candidemia in a pediatric intensive care unit. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2004 Jul;5(4):369-74. PubMed PMID: 15215008.
• 18. Arslankoylu AE, Kuyucu N, Yilmaz BS, Erdogan S. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit. Italian journal of pediatrics. 2011 Nov 21;37:56. PubMed PMID: 22104492. Pubmed Central PMCID: 3227576.
• 19. Tadec L, Talarmin JP, Gastinne T, Bretonniere C, Miegeville M, Le Pape P, et al. Epidemiology, risk factor, species distribution, antifungal resistance and outcome of Candidemia at a single French hospital: a 7-year study. Mycoses. 2016 May;59(5):296-303. PubMed PMID: 26806101.
• 20. Singhi S, Deep A. Invasive candidiasis in pediatric intensive care units. Indian journal of pediatrics. 2009 Oct;76(10):1033-44. PubMed PMID: 19907936.